Singles

Please take the next 30 minutes or so to complete this inventory. By completing this, it gives your counselor good preliminary information in order to get a “running start” in the early sessions.

The heart of biblical counseling is in the fundamental belief that the Bible is completely sufficient to meet all of life’s most difficult circumstances. Thus, our counseling keeps the Bible at the forefront of everything we teach and counsel.

Although our counseling is free, we have four primary requirements for counseling. If you can agree to these, please complete the form below.

You must be teachable

You must be honest

You must do your homework

If able, you must attend Community Bible Church during the time you are being counseled (it is not a requirement to give or serve)

If you have any questions about our counseling ministry, call (352) 229-2060. Our secretary works as a volunteer so if she cannot answer the phone, please leave a message and your call will be returned as quickly as possible.

General Information

Your Name(required)

Sex (required)

Age(required)

Street Address(required)

Email(valid email required)

City(required)

State(required)

Zip(required)

Occupation

Phone(required)

Education (Last year completed)

Other training (list types and years)

Referred by:(required)

Health Information

Rate your health (required)

Have you had any significant weight changes recently? (required)

List all important present or past illnesses, injuries or handicaps

Date of last medical examination

Report from that examination

Are you presently taking medication? (required)

If yes, what medication?

Have you ever had a severe emotional upset? (required)

If yes, explain

Religious Background

Denominational Preference

Are you a member? (required)

Church attendance per month (required)

Do you consider yourself a religious person? (required)

Do you believe in God? (required)

How often do you pray to God? (required)

Are you saved? (required)

If yes, briefly describe how someone gets saved

How often do you read the Bible? (required)

Do you have regular family devotions? (required)

Explain recent changes in your religious life, if any

Personality Information

Have you ever had any coaching, psychotherapy or counseling before? (required)

If yes, explain

Describe your personality(required)

Have you ever felt people were watching you? (required)

Do people's faces ever seem distorted? (required)

Do colors ever seem too bright or to dull? (required)

Are you sometimes unable to judge distance? (required)

Have you ever had hallucinations? (required)

Are you afraid of being in closed in spaces? (required)

Do you have problems sleeping? (required)

Family Information

Have you ever been married?

If yes, what is your current status?

Please list all children (if any)

If you were reared by anyone other than your parents, briefly explain

How many older siblings do you have?

How many younger siblings do you have?

General Questionnaire

What is/are the main problems as you see it?(required)

What have you done about it?(required)

What do you fear? What do you tend to worry about?(required)

What can a counselor do? What are your expectations in having a counselor?(required)

Describe your motivation for wanting change(required)

What are your three strongest talents?(required)

What are your three weakest areas?(required)

In writing your epitath, what would you want people to say about you?(required)

What are you doing in your life now that will last forever?(required)

Please write any other pertinent information you'd like your counselor to know?

Are you willing to be teachable, honest, and will you do your homework? (required)

Are you able to attend Community Bible Church while under counseling? (required)

Related Pages

Service Times

Sunday School: 9:00am

Sunday Service: 10:00am

CBC Newsletter

Our weekly newsletter is designed to help you in your walk with Christ as well as giving information for what's going on in the life of the church. Fill in the information below to begin receiving our newsletter.

Need Counseling?

Many people have situations in their lives they need counseling through. Others simply need wise counsel to work through a situation. Whatever your need is, we want to help. Please click here to learn more.